In-hospital formula feeding, family history help explain breastfeeding gaps

A national research collaboration funded by the National Institutes of Health has found significant racial and ethnic disparities in breastfeeding outcomes, according to a study published online this week in Pediatrics.

"We found that higher rates of poverty and lower levels of education helped explain breastfeeding gaps between black and white women, especially in determining whether mothers started breastfeeding in the first place," said Sharon Landesman Ramey, a professor and distinguished research scholar at the Virginia Tech Carilion Research Institute and an author of the paper. "But those factors weren't the only ones responsible for mediating these relationships."

The researchers focused on understanding nondemographic factors that might help explain the differences in breastfeeding among black, white, and Hispanic mothers in the United States.

They found a surprising discrepancy in the mothers' initial decision to breastfeed -- black mothers were nine times more likely to be given formula for their babies than white mothers in the hospital.

"Our results suggest that hospitals and policy makers should limit in-hospital formula introduction and consider family history and demographics to reduce racial and ethnic breastfeeding disparities," said Madeleine Shalowitz, a director at the NorthShore University Health System Research Institute and co-investigator on the study.

The American Academy of Pediatrics recommends children should be exclusively breastfed for the first six months of life, with continued breastfeeding and complementary foods until the child's first birthday at a minimum.

Even with this recommendation, about half of children in the United States are weaned from breastfeeding by the time they are six months old.

"Substantial research shows that breastfeeding benefits the neurologic, immunologic, digestive, and physical development of children," said Ramey, who is also a research professor in Virginia Tech's department of psychology. "These are lifelong benefits, yet some women choose not to do so. We investigated why that is."

The results not only explained some of the breastfeeding gap between black and white mothers, but they also elucidated why Hispanic mothers have the highest breastfeeding rate.

"It's family history," Ramey said. "Hispanic women are far more likely to have a family member who breastfed than white or black mothers."

The finding is important because Hispanic women tend to have similar economic standing and education levels as black women.

"This study finds a relationship between family experience with breastfeeding and Hispanic mothers' success at maternal nursing, and also finds that in-hospital provision of free infant formula is related to black mothers' poorer breastfeeding outcomes," said Bernice Hausman, the Edward S. Diggs Professor in the Humanities at Virginia Tech's College of Liberal Arts and Human Sciences. Hausman, an expert on the cultural aspects of breastfeeding, is also a professor at the Virginia Tech Carilion School of Medicine. She was not involved in this study.

Researchers collected data on attitudes toward breastfeeding, family history, introduction to formula while still in the hospital, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children. Commonly known as WIC, the program offers assistance to low-income women and their children.

All told, data was obtained from 1,636 mothers who delivered babies in Los Angeles, California, Baltimore, Maryland, Washington, D.C., and Lake Country, Illinois. The scientists assessed the mother's immediate intent regarding breastfeeding, and they followed-up one month and again six months after birth.

"Future studies might be able to clarify clear causative relationships between mediating factors and outcomes, but at least we can begin to move beyond broad cultural generalizations that are often unhelpful in changing the specific practices that negatively influence breastfeeding outcomes," Hausman said.

Hausman also noted the detailed level of information collected for the study.

"Hopefully breastfeeding promotion programs can use this kind of research to move beyond a model of educating mothers toward one that looks to the structural impediments to optimal breastfeeding outcomes," she said.

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The study was supported by grants to the Community and Child Health Network through cooperative agreements with the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute for Nursing Research. Funded by the National Institutes of Health.

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